AMSA members,

The article below is written by Steven Miles, MD, of the University of
Minnesota Center for Bioethics and appears in today's Star Tribune Op/Ed
section.

Peace,
Caleb Schultz
AMSA National Treasurer
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Steven Miles: A troubling silence from prison medics
Steven Miles 
May 18, 2004MILES0518
As the many layers of horror of the abuse and torture of Iraqi prisoners at
Abu Ghraib are explored, one tier remains unexamined. Why were the prison's
military physicians and medics silent as the prisoners they were treating
were tortured?

The evil of torture can hardly be worsened. But we instinctively react with
revulsion to physicians who are its accomplices in deed or in silence. The
first Nuremberg trials were of physicians who tortured people at Nazi death
camps. Japan's and Argentina's physicians supervised torture. Iraqi
physicians who participated in torture under Saddam Hussein were a
prominent and feared part of that gruesome regime. 

A tortured prisoner is alone -- the betrayal by health professionals
emphasizes his or her utter lack of protection.

The U.S. government admits that the Geneva Convention applies to prisons
established and supervised by the U.S. military in Iraq. This convention
bars physical or mental torture. Quibbles over whether the detainees were
POWS, irregular combatants, insurgents or common criminals make no
difference.

The United Nations' "Body of Principles for the Protection of All Persons
under Any Form of Detention or Imprisonment" says that humane and dignified
treatment is owed them all. In United States vs. Noriega, the U.S. Supreme
Court said that U.S. prison officials "must keep in mind the importance to
its own troops of faithful ... adherence to the mandate of Geneva."

"Regardless of how the government views this defendant as a person, the
implications of a failure to adhere to the Convention are too great to
justify departures."

Why were military physicians and medics silent as their patients were
tortured? Silence was not an option. 

The World Medical Association's Declaration of Tokyo and the U.N.'s
Principles of Medical Ethics forbid physicians from condoning,
participating in or appearing to support torture or inhuman or degrading
treatment, in any situation including war. The mere presence of a military
physician during any inhumane treatment of detainees is a violation of the
physician's "service of humanity."

International agreements say that officials who have reason to believe that
a torture "has occurred or is about to occur" must report the matter to
their superior authorities and, where necessary, to "other appropriate
authorities or organs vested with reviewing or remedial powers." 

The World Medical Association and numerous other groups aggressively
support physicians who report torture and protocols describing the medical
evaluation and recording of torture-related injuries.

The U.S. Army's Taguba report shows that medics saw the degradation of
prisoners at Abu Ghraib. It is widely reported that these same health
professionals treated wounds and observed the bodies of those who died
during interrogation.

The military command could not legally authorize torture. Even it did so or
even if it allowed torture to flourish, the physicians at Abu Ghraib were
morally obliged to serve their patients' welfare. The collapse of their
independent moral action is another sign that the incidents at Abu Ghraib
prison were more than the acts of a few bad apples. Military torture is
rarely an incident. It is a culture where prisoners are dehumanized and
isolated and where prison officials operate without administrative or moral
accountability.

We must ensure that the U.S. military code of medical ethics and a more
robust system of international law rise from this ruin.

Steven Miles is a professor of medicine and geriatrics at the University of
Minnesota's Center for Bioethics.